Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Study shows for first time decrease in mortality associated with physician order entry system

Researchers at Lucile Packard Children's Hospital and Stanford University School of Medicine have shown for the first time that a significant decrease in hospital-wide mortality rates can be associated with implementation of a computerized physician order entry system.

The system, launched at Packard Children's in 2007, was correlated with a 20 percent decrease in mortality rates at the hospital over an 18-month period, according to a new study to be published online May 3 in Pediatrics. Researchers noted that other patient care initiatives at the hospital may also have contributed to this important change.

With CPOE, doctors and other medical staff can prescribe medications, tests and other treatments electronically, making the instructions instantly and remotely available to all authorized hospital staff, even when off-site. CPOE is part of the hospital's electronic medical record, which also provides on screen the latest images and test results. All physicians need to do is boot up a computer, punch in a password and the heartbeat of a child in the neonatal intensive care unit will trace across the screen, or a brain scan can be viewed.

The study arrives as a debate rages over the benefits of CPOE and electronic medical records. While many proponents, including the Obama administration, see these new technologies as critical to improving the quality of our health-care system, critics contend their value has yet to be proven, particularly as some past research has shown negative consequences, including one site that witnessed an increase in mortality.

"Prior to our report, no hospital or medical institution has shown that CPOE can be implemented and actually have an associated decline in mortality," said lead author Christopher Longhurst, MD, medical director of clinical informatics at Packard Children's and assistant clinical professor of pediatrics at Stanford. "But what we found is that CPOE implementation was statistically correlated with fewer patient deaths. As you can imagine, this is very meaningful." Longhurst was part of a team of eight researchers from Packard Children's, Stanford and Harvard University involved in the study.

Mark Del Beccaro, MD, a pediatrics professor and vice chair for clinical affairs at Seattle Children's Hospital, who was not involved in this study, said he welcomed the new findings. Seattle Children's Hospital implemented CPOE in 2003. "Three years later a study of the effects showed mortality rates at our institution held steady," Del Beccaro said. "As the evolution and maturity of these systems and their benefits are being realized, there has been soft evidence that they improve patient safety. The Packard Children's report is the first I am aware of to show that you can potentially affect mortality by putting CPOE in place. This is an important study, and we hope others can realize these benefits."

Longhurst emphasized that the new results show a correlation, not a cause and effect. "Our implementation of CPOE was executed superbly, but in addition, we were simultaneously making other advances in patient care," he said. "These included process and workflow changes, adjustments in ICU staffing, the rollout of Rapid Response Teams, the implementation of a nursing residency and more, all in the face of rising acuity in the hospital."

To determine if a change in mortality rates occurred, Longhurst and his colleagues reviewed nearly 100,000 discharges from Packard Children's from Jan. 1, 2001, through April 30, 2009. They compared the observed mortality with the expected mortality, which was generated from a database of 42 tertiary-care, not-for-profit pediatric hospitals similar to Packard Children's.

The result of their analysis was a finding of two fewer deaths per 1,000 discharges at Packard Children's in the period after CPOE was implemented, a total of 36 lives over 18 months.

There are many ways CPOE can have a lifesaving impact. With CPOE, crucial data and suggestions that can help guide clinical decisions pop up on the screen as the doctor types in orders and other information about the patient. There will be, for instance, a friendly electronic nudge if a dosing calculation appears to be in error. And it can improve efficiency. "We've seen a 20 percent improvement in the time from order to administration for 'stat' [immediate] medications," noted Longhurst. "This can have lifesaving consequences."

Still, it's important to remember that CPOE, and electronic medical records in general, are simply technology tools that support or "hard-wire" best practices into the work environment. "Simply purchasing a fancy and expensive electronic medical records system in and of itself is not likely to make much of a positive impact on quality or patient safety," said Paul Sharek, MD, MPH, medical director of quality management and chief clinical patient safety officer at Packard Children's. "What provides the real opportunities for improving care is using this technology to support best practice, such as displaying relevant blood test results at the time physicians are ordering medications, or allowing practice guidelines to be immediately available to physicians at the time of order entry." Sharek, who is an assistant professor of pediatrics at the medical school, is the study's senior author.

Longhurst concluded: "We believe our experience is proof that CPOE is here to stay. However, to be successful, it takes an unwavering commitment to implementation. Our staff was very supportive, seeing it as a critical part of a hospital-wide commitment to continuous improvement in patient care. This approach gave us a better chance to determine if CPOE really has an impact in a hospital setting."

Other Stanford/Packard Children's authors on the study are Christopher Dawes, MBA, the hospital's president and chief executive officer; Jill Sullivan, RN, MSN, vice president of hospital transformation; Christy Sandborg, MD, professor of pediatric rheumatology and the hospital's chief of staff; Jin Hahn, MD, professor of pediatric neurology; and Eric Widen, MHA, administrative director of performance improvement at the hospital.

The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit

Ranked as one of the best pediatric hospitals in the nation by U.S.News & World Report, Lucile Packard Children's Hospital at Stanford is a 312-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with the Stanford University School of Medicine, Packard Children's offers patients locally, regionally and nationally the full range of health-care programs and services — from preventive and routine care to the diagnosis and treatment of serious illness and injury. For more information, visit

Robert Dicks | EurekAlert!
Further information:

More articles from Studies and Analyses:

nachricht Diagnoses: When Are Several Opinions Better Than One?
19.07.2016 | Max-Planck-Institut für Bildungsforschung

nachricht High in calories and low in nutrients when adolescents share pictures of food online
07.04.2016 | University of Gothenburg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New 3-D wiring technique brings scalable quantum computers closer to reality

Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.

"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...

Im Focus: Scientists develop a semiconductor nanocomposite material that moves in response to light

In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.

A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...

Im Focus: Diamonds aren't forever: Sandia, Harvard team create first quantum computer bridge

By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.

"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...

Im Focus: New Products - Highlights of COMPAMED 2016

COMPAMED has become the leading international marketplace for suppliers of medical manufacturing. The trade fair, which takes place every November and is co-located to MEDICA in Dusseldorf, has been steadily growing over the past years and shows that medical technology remains a rapidly growing market.

In 2016, the joint pavilion by the IVAM Microtechnology Network, the Product Market “High-tech for Medical Devices”, will be located in Hall 8a again and will...

Im Focus: Ultra-thin ferroelectric material for next-generation electronics

'Ferroelectric' materials can switch between different states of electrical polarization in response to an external electric field. This flexibility means they show promise for many applications, for example in electronic devices and computer memory. Current ferroelectric materials are highly valued for their thermal and chemical stability and rapid electro-mechanical responses, but creating a material that is scalable down to the tiny sizes needed for technologies like silicon-based semiconductors (Si-based CMOS) has proven challenging.

Now, Hiroshi Funakubo and co-workers at the Tokyo Institute of Technology, in collaboration with researchers across Japan, have conducted experiments to...

All Focus news of the innovation-report >>>



Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

Agricultural Trade Developments and Potentials in Central Asia and the South Caucasus

14.10.2016 | Event News

World Health Summit – Day Three: A Call to Action

12.10.2016 | Event News

Latest News

Resolving the mystery of preeclampsia

21.10.2016 | Health and Medicine

Stanford researchers create new special-purpose computer that may someday save us billions

21.10.2016 | Information Technology

From ancient fossils to future cars

21.10.2016 | Materials Sciences

More VideoLinks >>>